Background Individual surgical risk assessment (ISRA) enhances patient care experience and outcomes by informing shared decision-making, strengthening the consent process, and supporting clinical management. Neither the use of individual pre-surgical risk assessment tools nor the rate of individual risk assessment documentation is known. The primary endpoint of this study was to determine the rate of physician documented ISRAs, with or without a named ISRA tool, within the records of patients with poor outcomes. Secondary endpoints of this work included the effects of age, sex, race, ASA class, and time and type of surgery on the rate of documented presurgical risk. Methods The records of non-obstetric surgical patients within 22 community-based private hospitals in Arizona, Colorado, Nebraska, Nevada, and Wyoming, between January 1 and December 31, 2017, were evaluated. A two-sample proportion test was used to identify the difference between surgical documentation and anesthesiology documentation of risk. Logistic regression was used to analyze both individual and group effects associated with secondary endpoints. Results Seven hundred fifty-six of 140,756 inpatient charts met inclusion criteria (0.54%, 95% CI 0.50 to 0.58%). ISRAs were documented by 16.08% of surgeons and 4.76% of anesthesiologists (p < 0.0001, 95% CI −0.002 to 0.228). Cardiac surgeons documented ISRAs more frequently than non-cardiac surgeons (25.87% vs 16.15%) [p = 0.0086, R-squared = 0.970%]. Elective surgical patients were more likely than emergency surgical patients (19.57 vs 12.03%) to have risk documented (p = 0.023, R-squared = 0.730%). Patients over the age of 65 were more likely than patients under the age of 65 to have ISRA documentation (20.31 vs 14.61%) [p = 0.043, R-squared = 0.580%]. Only 10 of 756 (1.3%) records included documentation of a named ISRA tool. Conclusions The observed rate of documented ISRA in our sample was extremely low. Surgeons were more likely than anesthesiologists to document ISRA. As these individualized risk assessment discussions form the bedrock of perioperative informed consent, the rate and quality of risk documentation must be improved.
Background Individual surgical risk prediction tools that inform shared-decision making, strengthen the consent process and support clinical management are considered important tools to enhance patient experience and outcomes. Neither the use of individual pre-surgical risk assessment (ISRA) tools nor the rate of documented individual risk is known. The primary endpoint of this study was the rate of physician documented ISRAs within the records of patients with poor outcomes. Secondary endpoints included the effects of age, sex, race, ASA class, and time and type of surgery on the rate of documented presurgical risk.Methods The records of non-obstetric surgical patients within 22 hospitals in Arizona, Colorado, Nebraska, Nevada, and Wyoming, between January 1 and December 31, 2017 were evaluated. Logistic regression was used to analyze both individual and group effects associated with ISRA documentation.Results 756 of 140,756 inpatient charts met inclusion criteria [0.54%, 95% CI 0.50% to 0.58%]. ISRAs were documented by 16.08% of surgeons [p<0.0001; R-squared=68.23%] and 4.50% of anesthesiologists [p< 0.0001, R-squared 15.38%]. Cardiac surgeons documented ISRAs more frequently than non-cardiac surgeons (25.87% vs 16.15%) [p=0.0086, R-squared=0.970%]. Elective surgical patients were more likely than emergency surgical patients (19.57 vs 12.03%) to have risk documented [p=0.0226, R-squared=0.730%]. Patients over the age of 65 were more likely than patients under the age of 65 to have ISRA documentation (20.31 vs 14.61%) [p=0.0429, R-squared=0.580%].Conclusions The observed rate of documented individual surgical risk assessment in our sample was low. Surgeons were more likely than anesthesiologists to document individual presurgical risk. In-line with the Salzburg Statement on Shared-Decision Making, information regarding surgical risk represents the bedrock of presurgical decision making and informed consent. The rate and quality of risk documentation must be improved.
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